Treatment of Bulimic Adolescents

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

Anorexia-Bulimia Home Treatment Program

By Wilbur Mitch on Wed, 05 Sep 2018

The best way to treat Anorexia Bulimia is at home with an individual program. This gives people a chance to control their behavior by themselves and not be dependent on a group or a therapist. The Positive Energy Treatment is the anorexia and bulimia selfhelp method discovered by Karen Phillips. This method is based on the belief that recovering from bulimia requires you to change your subconscious mind. You need to change negative feelings and thoughts into positive ones. You need to change a negative identity into a positive one.

AnorexiaBulimia Home Treatment Program Summary

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My AnorexiaBulimia Home Treatment Program Review

All of the information that the author discovered has been compiled into a downloadable book so that purchasers of Anorexia-Bulimia Home Treatment Program can begin putting the methods it teaches to use as soon as possible.

Purchasing this e-book was one of the best decisions I have made, since it is worth every penny I invested on it. I highly recommend this to everyone out there.

You may have trouble understanding or agreeing with their concerns for your health and well being. You think you're on your way to achieving a very important goal and assume everyone who challenges you is jealous. You're able to ignore the reactions and rejection of people who have been part of your life, because the anorexia makes you believe you're strong and superior, in spite of the fact that others see and say that it's making you ill. However physically ill or weak you feel when you're starving yourself this way, however lonely and isolated you are, such things are secondary to the sense of power you believe you have over yourself and your hunger. And because they're secondary, you don't try to fix them. That sense of control and power will feed you (in the absence of actual food), and it will give you the impetus to continue your disordered patterns. Ironically, though, if you're anorexic, it's the anorexia that has the real control over you. You're trapped. The anorexic voice...

Anorexia is a self-starvation disorder that primarily affects females, although the number of males with anorexia is increasing. 2. Anorexia is triggered by a combination of factors physical, emotional, social, familial, genetic. 4. As anorexia progresses and your eating becomes restrictive, ritualized, and obsessive, your body will undergo dramatic physical changes. 6. Anorexia changes the way other people relate and react to you. 7. Some individuals with anorexia also binge and or purge. An accurate diagnosis is therefore important in order to receive appropriate treatment 8. A typical but inaccurate belief of many anorexics is that you need to be sick to be heard and taken seriously, because without the anorexia you will disappear and become invisible to family and friends. 9. Anorexia makes it almost impossible for you to see yourself as others see you.

Bulimia is another eating disorder that can be harmful to your physical and mental health like anorexia, it can result in death. Also, like anorexia, it is fueled by a dual obsession with both thinness and food. In fact, these two eating disorders have been called Cinderella's stepsisters and are often referred to as flip sides of the same coin. Unlike anorexia, which prompts you to starve yourself, bulimia (which literally means ox hunger) is most often a binge-purge pattern in which you feel an overwhelming urge to binge (eat a large amount of food in a short period of time) and then an equally overwhelming urge to purge (eliminate) from your body whatever foods and liquids were consumed during the binge. Methods of purging vary. Some bulimics make themselves vomit, while others abuse laxatives, emetics (medications that make you vomit), diuretics (chemicals that rid your body of fluids), enemas, diet pills, or a combination of these. Any method a bulimic person uses to purge is...

Sometimes an eating disorder is just the tip of the iceberg, and some susceptible individuals stmggle with two or more categories of emotional, physical, or behavioral problems. This is called dual diagnosis or comorbidity. One of the most common conditions that occurs with bulimia is depression, which affects between SO and 65 of bulimic women (T. Pearls tein, Eating disorders and comorbidity, Archives of Women's Mental Health (2002) 4 67-78.) People who suffer from depression have symptoms such as losing interest in things they used to love to do, feeling dejected or hopeless, experiencing changes in how their bodies function, feeling tired out of proportion to their physical activity, having school problems, and thinking about suicide. Bulimia often develops in response to or along with the depression. More examples of comorbidity are shown in the following statistics 71 of bulimic women have some kind of anxiety disorder and of those, 59 have social phobia. About one-third have a...

Note that overeating in and of itself does not lead to bulimia. Some binges are just splurges, mini self-indulgences that are fun and filled with the appreciation of food and the people with whom you share it. Some are opportunities to let off steam, reward yourself for an accomplishment, take a break in your routine, or give yourself a tirne-out from tedium. If you know why you're eating in this way, you don't follow the binge by a purge, or you don't find that occasional overeating or splurging interferes with how you live your life or think about your self-worth, your binge is not bulimic behavior. Generally speaking, bulimic binges are terrifying, out-of-control experiences that become intense, dominant, negative forces in your life. They hurt physically, are increasingly habit-forming, and are often accompanied by feelings of self-loathing. They are typically followed by a purge of some sort. Are You Bulimic A Checklist of Bulimic Behavior and Self-Talk This list is not meant to...

Bulimia is a pattern in which you binge (eat a huge amount of food in a short period of time) and then purge (eliminate) whatever you ate. 2. Bulimia is a self-destructive activity that makes it almost impossible to eat in a normal, unselfconscious way 3. Bulimic hunger is most often emotionally driven, binges and purges provide release but not pleasure, food becomes an antagonist, and eating is disconnected from physical and emotional nourishment 4. Bulimic binges and purges are habit-forming and become intense, negative forces that dominate your life and are hazardous to your emotional and physical health. 5. Bulimia is more prevalent than anorexia but is harder to detect because many bulimics are not obviously underweight and do not seem to restrict what they eat 6. Sometimes it's difficult to know if a person is really bulimic or has a form of anorexia that involves bingeing and purging. An accurate diagnosis from a health-care professional is needed to ensure the right kind of...

So, be prepared for the possibility that those initial steps meant to liberate you from the prison of your eating disorder will be tentative, shaky, and scary. You'll have to examine and challenge this drive for thinness, be willing to eat properly, exercise appropriately, honor your body's need for sleep, and come to terms with your body's natural shape. You might have to change friends if yours are obsessed with weight loss, or teach them what you're learning as you resolve the issues that landed you in this prison. You'll have to be willing to talk with your family and, eventually, your therapy team, about the changes going on inside your head.

Some people can't stand to look at meats others need to organize their foods in particular patterns on a plate some can tolerate only tiny amounts on a plate at any one time. Again,, try to change the power that the food on the plate has over you. Experiment. Pretend to be an artist working on a canvas. Change things around till you find a food or combination of foods that won't trigger anorexic or bulimic patterns. If you can get into the mind game of imagining yourself as an artist with the food as your medium, you might be able to distract or amuse yourself enough so that some of the emotional punch associated with food will be eliminated and you'll be able to eat with greater ease.

To date, systematic research in the treatment of bulimia nervosa has focused on adults. Significant progress has been made in understanding a range of efficacious treatments for adults with bulimia nervosa, including cognitive-behavioral therapy (CBT), interpersonal therapy, and antidepressant medications. In the largest clinical trial of psychological treatments for bulimia nervosa to date (N 220), the mean age of participants was 28.1 (SD 7.2) years (Agras et al. 2000). In research studies of these treatment approaches, the average age of participants was 28.4 years, the duration of the disorder was approximately 10 years (Agras et al. 1992, 2000 Fairburn et al. 1986b Wilson et al. 1991), and the cutoff age for entry was 18 years. Hence, the existing studies do not provide evidence about the effectiveness of CBT for adolescents with bulimia nervosa. Despite the fact that binge eating, purging, and many cases of bulimia nervosa begin during adolescence (Herzog et al. 1991 Lock et al....

The family-based treatment model for adolescent bulimia nervosa (FBT-BN) is derived from the Maudsley Hospital's family-based treatment for adolescents with anorexia nervosa (Eisler et al. 1997 Lock et al. 2001a, 2005 Russell et al. 1987). FBT-BN assumes that the secrecy, shame, and dysfunctional bulimia nervosa eating patterns have negatively affected an adolescent's development and confused and disempowered parents and other family members. Further disabling the family is parental guilt related to having possibly caused the illness and anxiety about how best to proceed. Le Grange et al. (2007) completed an RCT wherein 80 adolescents with bulimia nervosa, ages 12-19 years (M 16.1, SD 1.6), were allocated either to manualized FBT-BN or to manualized individual supportive psychotherapy. The authors found a statistically significant difference favoring FBT-BN over supportive psychotherapy in terms of abstinence at the end of treatment and at 6-month follow-up.

Others are intimidated and frightened, unsure how to respond, especially when you're in an eating-disordered mode. Some will speak to you out of concern or frustration because they care for and about you. Others will want to correct your thinking or cure your eating disorder, without really-knowing how. A battleground mentality can set in. The eating disorder becomes the enemy, you are its victim, and the other person (e.g., a parent, friend, relative, or teacher) becomes your helper or rescuer. Typically, several people will confront you about your eating habits, so it's possible to have many would-be rescuers. Some won't know specifically that what you have is an eating disorder and won't use technically correct terms to describe what they think you're doing. They may say, You're too thin or You're not taking care of yourself. People who are well-informed may try logic and offer facts about the dangers to your physical and mental health. My...

Hypothalamic amenorrhea (including eating disorders) Anorexia nervosa ing or exercise sufficient to accomplish their idealized body weight or percentage body fat. Therefore, a significant number of them diet and use harmful, ineffective weight-loss practices such as restrictive eating, vomiting, laxatives and diuretics to meet their goals 105 . Eating disorders are the common denominator for such behaviors. Eating disorders can result in short- and long-term morbidity, poor recovery, impaired sports performance and mortality 106-108 . Signs and symptoms of eating disorders in athletes are often ignored. In some sports disordered eating seems to be regarded as a natural part of being an athlete 109 . It has been claimed that female athletes are at increased risk for developing eating disorders due to the focus on low body weight as a performance enhancer, comments from coaches or others and the pressure to perform 108,110,111 . Symptoms of eating disorders are more prevalent among...

The etiology of eating disorders is multifactorial 123,124 . Because of additional stress associated with the athletic environment, however, female elite athletes appear to be more vulnerable to eating disorders than the general female population 111 . Furthermore, recent studies suggest that specific risk factors for the development of eating disorders occur in some sport settings one retrospective study indicated that a sudden increase in training load may induce a caloric deprivation in endurance athletes, which in turn may elicit biologic and social reinforcements leading to the development of eating disorders 108 . However, longitudinal studies with close monitoring of a number of sports-specific factors (volume, type and intensity of training) are needed to answer questions about the role played by different sports in the development of eating disorders in athletes. Female athletes with eating disorders frequently start sport-specific training at an earlier age than healthy...

Eating-disordered athletes are more likely to accept the idea of going for a single consultation than the idea of committing themselves to prolonged treatment. Themes and questions that should be included in the first consultation with athletes possibly suffering from eating disorders are listed in Table 4.6.10. Included in Table 4.6.11 is also what should be included in the review of system, evaluation, lab tests and treatment. Table 4.6.10 Physical symptoms, psychological and behavioral characteristics of athletes with eating disorders. Table 4.6.10 Physical symptoms, psychological and behavioral characteristics of athletes with eating disorders. * Anorexia nervosa. t Bulimia nervosa. In the Norwegian model, athletes with eating disorders receive individual therapy, a modified cognitive group therapy program and nutritional counselling. The first consultation with athletes with suspected or manifested eating disorders is extremely important. The goal is to create an alliance for...

It is likely that talking to athletes and coaches about eating disorders and related issues such as reproduction, bone health, nutrition, body composition and performance may help to prevent eating disorders in that population 120 . Therefore, coaches, trainers, administrators and parents should receive information about eating disorders and related issues. In addition, coaches should realize that they can strongly influence their athletes. Coaches or others involved with young athletes should not comment on an individual's body size, or require weight loss in young and still growing athletes. Without further guidance, dieting may result in unhealthy eating behavior or eating disorders in highly motivated and uninformed athletes 135 . Because of the importance that athletes ascribe to their coaches, the success of a prevention program tends to be related to the commitment and support of the coaches and others involved. Early intervention is also important, since eating disorders are...

Psychological therapy and medications have been used to help adolescents recover from anorexia and bulimia. When there is a related depression or anxiety disorder, antidepressants are often prescribed. If the eating disorder is severe the teenager's weight is 25 percent less than the average for her height and age hospitalization may be required. Then food can be introduced and intensive therapy given.

It's a natural and commendable impulse to want to help someone you care about work through a problem. When that person is struggling with anorexia or bulimia, your own skill and attitude are keys to successful results. You'll have to draw upon your knowledge of eating disorders, be aware of the limits of your effectiveness, and pick the right time to intervene.

It's often said that, timing is everything ' This bit of folk wisdom applies here. Wanting to be helped and being ready to accept help aren't necessarily the same things, but fall along a continuum of readiness factors determined, in part, by how long the eating disorder has been in place. Remember that anorexic and bulimic behaviors can become obsessions, compulsions, and addictions, and they gain more and more control of their victims the longer they're allowed to persist. So, unless the person has willingly opened up to you first, you can increase your chances of getting a positive response by waiting for the right time. On the other hand, if the person you're trying to help is 5'8, weighs 80 pounds, and wants to lose more weight, or can't eat a meal without vomiting immediately afterward, or has to engage in a minimum of five planned binge-purge episodes, he or she won't be able to hear your words of caution, logic, and concern. That person will defend the eating disorder and...

People who joke about being anorexic are probably trying to say that they wish their bodies were thinner. If that's what you want to talk about, say so. However, you should avoid comparisons about body shape or weight since that kind of discussion often triggers a competitive need in the anorexic or bulimic person to win at the imagined thinness competition, as we've discussed previously. Don't make an eating disorder seem like a desirable condition, especially to someone who might grasp at any straw to justify continuing that behavior.

Combating an eating disorder is huge and generally involves a collaborative team of specialists, including a psychiatrist (or psychologist) to work through the psychological dynamics, a physician to monitor physical status, and a nutritionist (or dietitian) to reintroduce food as an ally not an enemy. Here are some things you can do if you suspect a friend or family member has an eating disorder The following organizations can provide information, literature, and qualified referrals for the treatment of eating disorders National Eating Disorders Association National Association of Anorexia Nervosa and Associated Disorders Eating Disorders Clinic Treatment is free for individuals who meet criteria for this research program. Eating Disorder Program Anorexia nervosa is a life-threatening eating disorder that involves self-induced starvation and refusal to maintain a normal healthy weight. Bulimia nervosa is a serious eating disorder that involves repeated episodes of rapidly consuming...

L For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses. 2. AH of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual's current weight is in the normal range. 3. All the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than three months. Binge-eating disorder recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.

If you're female, bulimia can cause menstrual irregularity, but a study done at the University of Minnesota Medical School has found that bulimia appears to have no long-term impact on a woman's ability to become pregnant (American Journal of Psychiatry2002 159 10481050).

The binge continues until no more food remains, the pain in your stomach becomes severe enough to get your attention, or an outside interruption (a phone call, ringing doorbell, barking dog, someone coming into your space) breaks into your bulimic zone. Here's a letter I received that describes a bulimic binge Dear Nancy, As an alternative or adjunct to vomiting, many bulimics take laxatives, diet pills, or emetics immediately after a binge since the fantasy is that this will cause weight loss. However, as the bulimia continues, you will have to take bigger doses to get the results you initially had water loss, diminished hunger, the sense that you've cleaned out your system. This escalation of abuse is exactly what happens if you're addicted to alcohol or drugs.

In adolescent girls, eating disorders are the third leading chronic illness, after obesity and asthma. The number of young people diagnosed with eating disorders (anorexia nervosa or bulimia nervosa) and eating disturbances (some but not all criteria for diagnosis of a disorder) is increasing, the result of a combination of improved recognition and reporting, as well as an apparent true increased incidence. About 95 of cases are female, and the prevalence of eating disorders has been directly correlated to the rates of dieting behavior. High-risk groups include female athletes and diabetic patients. An individual with anorexia nervosa refuses to maintain a minimally normal body weight, is fearful of gaining weight, and exhibits a distorted body self-image. If she is postmenarchal, she is amenorrheic. The long-term mortality rate for anorexia nervosa is 6 to 20 , the highest rate for any psychiatric disorder (Roerig et al., 2002), often as an acute suicidal act rather than slow bodily...

In the later stages of anorexia, your voice can literally become very small, like a whisper. The words you speak are often tentative, your sentences terse, with confusion and ambivalence peppering the things you say. Since sex is a form of communication, and since anorexia alters how you communicate all aspects of your self, physically intimate experiences are often transformed from occasionally awkward to frightening. Many anorexics report completely losing their sexual feelings and sex drive. This may be a result of hormonal deficiencies but also may be due to a psychological walling-off of emotions, a profound lack of trust in interpersonal relationships, a fear of being naked, a literal fear of being touched and of touching someone else. Sexual dysfunction is a complicated and serious side-effect of this disorder.

Nutritional status of anorexic girls improved in a year's time, the bone mineral density improved more slowly than in girls who had no history of anorexia (journal of Clinical Endocrinological Metababolism, Sept. 2002, 87-9 4177-85). Researchers in Denmark believe that anorexia may cause permanent skeletal damage that is later made worse by the normal bone loss that occurs with aging. This study found that compared with non-eating-disordered people, anorexic patients were approximately twice as likely to break a bone the risk remained for up to 10 years post-diagnosis (International Journal of Eating Disorders, 2002,32 301-308). For a more thorough discussion of osteoporosis and bone density testing, an excellent resource is the Mayo Foundation for Education and Research, www.mayvclinic.com. Another interesting Harvard study based on interviews with hundreds of ninth and tenth grade girls found that those girls had a higher chance of suffering bone fractures if they drank cola five...

Post-hibernation anorexia can also be the result of a more gradual build-up of urates in the kidneys brought about by a combination of the tortoise suffering a series of poor summers and hibernation in which energy levels are slowly being reduced and urate levels increased. A healthy adult tortoise can be expected to lose about 1 of its body weight during each month of hibernation. A hatchling will lose much more and, if it loses more than 10 , must be brought out of hibernation.

Bulimia nervosa is an eating disorder with significant associated physical complications. It is characterized by binge eating with self-induced vomiting, laxative use, dieting, and exercise to prevent weight gain. Patients with bulimia are at risk for damage to the dental enamel and dentin as a result of repeated episodes of vomiting with chronic exposure to regurgitated acidic gastric contents. The lingual dental surfaces are most commonly affected. In severe cases, all surfaces of the teeth may be affected. Buccal dental surface erosions may be noted as a result of excessive consumption of fruit (ie, lemons) and juices by some bulimic patients. Trauma to the oral and esophageal mucosa may also result from induced vomiting. The quantity, buffering capacity, and pH of both the resting and stimulated saliva are found to be reduced. Salivary gland enlargement, most commonly the parotid, may occur as well.

Bulimia transforms the meaning and significance of eating into a self-destructive activity that makes it just about impossible to eat normally and unselfconsciously. Food becomes an antagonist rather than a source of pleasure and a way to socialize with others. Eating becomes disconnected from anything that would nourish you either physically or emotionally. How does this happen Let's look at a typical case.

Anorexia nervosa is a complex psychological disorder that literally involves self-starvation. People who suffer from this illness eat next to nothing, refuse to maintain a healthy body weight for their corresponding height, and frequently claim to feel fat even though they are obviously emaciated. Because anorexics are severely malnourished, they often experience symptoms of starvation brittle nails and hair dry skin extreme sensitivity to the cold anemia (low iron) lanugo (fine hair growth on body surface) loss of bone swollen joints and dangerously low blood pressure, heart rates, and potassium levels. If not caught and treated in time, victims of anorexia nervosa can literally diet themselves to death. The prevalence of anorexia nervosa is estimated at 0.1-0.6 percent of the general population 90 percent of the sufferers are women and roughly 6 percent are boys and young men. Although any personality can fall victim to this life-threatening illness, most anorexics tend to be...

Soon after starting the binge, you enter a bulimic zone and lose touch with your body and your surroundings. At this point, there's little chance that you'll taste or savor anything other than those initial bites of food. The physical act of eating the food during a binge is often mechanical chew, swallow, chew, swallow. You will probably ignore the painful sensations you're apt to get when your stomach becomes distended and in distress.

An additional and somewhat unique concern in children and adolescents with diabetes is the occurrence of disordered eating. Such disordered eating is believed to be the result of both the focus that the treatment of diabetes places on dietary intake and the fact that treatment modalities often result in weight gain. However, some controversy exists regarding the prevalence of disordered eating in individuals with type 1 diabetes. Some studies have found no significant increase in diagnoses of eating disorders, yet other studies have found a higher incidence of eating disorders and eating disorder-type behaviors in individuals who have type 1 diabetes. In addition, as in the general population, younger adolescent females with type 1 diabetes appear to be the most susceptible to the development of an eating disorder (Jones et al. 2000 Meltzer et al. 2001 Verrotti et al. 1999). The treatment for diabetes itself has also been used by some adolescents to manipulate their weight....

The epidemiology of eating disorders poses a particular challenge to investigators due to problems with case definition, and the tendency of eating-disordered subjects to conceal their illness and avoid professional help. Estimates of the prevalence of the symptoms of eating disorders and clinical eating disorders among female athletes range from less than 1 to as high as 75 108,118,119 . The prevalence of anorexia nervosa (2.2 ), bulimia nervosa (7.2 ) and subclinical eating disorders (10 ) are more prevalent among female elite athletes than non-athletes 120 . Furthermore, this study showed that eating disorders are more frequent among female elite athletes competing in aesthetic and weight-class sports than among other sport groups where leanness is considered less important E The disturbance does not occur exclusively during episodes of anorexia nervosa Table 4.6.9 The 'eating disorder not otherwise specified' category. 1 All of the criteria for anorexia nervosa are met except the...

Feeding difficulties are common in infants and young children. Most are minor and self-limited and can be addressed through education and reassurance of caregivers. However, physicians must be alert for specific feeding and eating disorders that can lead to malnutrition or chronic toxicity from ingested substances. The most important of these are listed in DSM-IV-TR as Feeding Disorder of Infancy or Early Childhood. The diagnosis has previously been described as psychosocial failure to thrive and psychosocial dwarfism. The key feature of the diagnosis is that the child fails to gain weight appropriately over a prolonged time, which is not fully explained by a gastrointestinal, endocrinologic, or neurologic condition. Of children admitted to the hospital for failure to thrive, as many as half have a psychosocial etiology.

Anorexia nervosa is a psychophysiological disorder especially prevalent among young women and characterized by refusal to eat or maintain normal body weight, intense fear of becoming obese, a disturbed body image in which the emaciated patient feels overweight, and absence of any physical illness accounting for extreme weight loss. The term anorexia is actually a misnomer, because genuine loss of appetite is rare and usually occurs only late in the illness. Most anorectics are actually obsessed with food and constantly deny natural hunger.

A series of double-blind, placebo-controlled trials of antidepressants has been conducted in adults with bulimia nervosa (Agras and McCann 1987 Agras et al. 1992 Walsh 1991 Walsh et al. 1991, 1997). In almost all of these trials, most types of antidepres-sants have proven superior to placebo in reducing binge frequency. Mood disturbance and preoccupation with body shape and weight have also shown greater improvement with medication than with placeb o (Mitchell et al. 1993b). In several controlled studies, the relative and combined effectiveness of CBT and antidepressant drug treatment have been directly evaluated (Agras et al. 1992 Leitenberg et al. 1994 Mitchell et al. 1993a, 1993b Walsh et al. 1997). Although antidepressant medications have been shown to be more effective than placebo in reducing bulimia nervosa symptoms, when added to psychological treatments (e.g., CBT or interpersonal therapy), medications did not improve the outcomes of core eating-related symptoms (Pope et al....

As the anorexia progresses, you lose tolerance for things and people you used to like. You become very self-centered and choose to isolate yourself as much as possible. When you do reach out and try to spend time with other people, you often alienate them. If you ask for advice, you're likely to reject it immediately you want your opinions to be accepted without question or you get insulted and defensive. Since you cannot accurately see how your body looks, you assume that anyone who challenges your vision is wrong. Often, you can't see the other person's point of view and may not even want to. At this stage of anorexia, it's not unusual to skip school or work, stay in sweats or pajamas all day, and to stop the basic grooming that you'd otherwise do without a second thought like showering, combing your hair, and brushing your teeth. Some people are literally afraid to look at themselves when they are naked, and others can't touch themselves when showering or bathing because they...

Not only does anorexia affect your body and your personality, it also changes the way other people relate and react to you. When you're severely emaciated, people who haven't seen you for a while may actually pull away when you meet because they're afraid of what they're observing and unsure of how to react. People who are in touch with you on a regular basis often vacillate between being overly kind and sweet, treating you as if you were feeble and fragile, and trying a get tough tactic with you to convince you to give up your anorexia, by threatening, ranting, and fighting with you. Your parents can even get into battles with each other. They may not agree on how to handle you. One parent may feel left out if you seem to be closer to the other. Their own relationship may suffer and they may try to make you feel guilty and responsible for their problems. Sometimes it may seem they want you to do one thing and will tell you so, then change their minds in the middle of a conversation...

It's not unusual for bulimic symptoms to also coexist with other risk-taking behaviors. Many people who develop bulimia also struggle with alcohol and or drug abuse. Some have problems with impulse control and get in trouble for shoplifting and other forms of theft. Many bulimics are also cutters who self-rnutilate at times. (This is also true of anorexics who have a binge-purge variety of the disorder.) If any of these situations applies to you, ifs important to own up to them so that all components of your particular set of challenges will be addressed in therapy's

Bulimia also changes your relationships with others. It makes you afraid to eat anywhere with family or friends because you don't have confidence that you can control the urge to binge, or because you're no longer capable of eating anything, even if it isn't part of a binge, without having to purge it immediately afterwards. If you keep your bulimia a secret buried deep inside you, without admitting it to family and friends, that secrecy becomes another barrier, which separates you from the very people who could help you. turmoil. This discomfort can lead to a chain of events in which your family or friends avoid you, you avoid them, you isolate and feel like an outcast, and escalate the bulimia as the way to cope. (There is a certain irony in this because often bulimia is a way to fill emotional voids, described as emptiness.) Things at home (or school if you live away from home) can go from bad to worse. Your purging starts to impinge on the family or group turf the bathrooms reek,...

An eating disorder It was so hard to admit I didn't want that label I was mad that I was found out Sometimes I want help, while at other times I don't One of the toughest aspects of being a teenager or young adult is wanting everyone to think you've got your act together when you're also struggling with questions like, Who am I What do I want to do with my life Does anyone really love me Will I ever be happy Will I be a success How can I be everything that everyone expects me to be and so on. It's hard to maintain a veneer of competence when you're thinking, I suck at life. While there are many factors that contribute to the development of an eating disorder, this uncertainty about who you are and what you stand for can make you particularly susceptible. For this reason, the first steps that you need to take in overcoming your eating disorder involve getting to know yourself and your unique situation. This includes examining your discomforts and dissatisfactions with the reality of...

A number of tools can help you get comfortable with this initial process of recovery, some of which you may already know about, such as journal writing, taking relaxation breaks, and cultivating relationships with people you trust and enjoy. Other steps will probably be new to you, such as taking dictation from yourself by answering deeply personal questions noting, challenging and changing your negative self-talk and negative triggers and defusing your eating environment one step at a time to help you begin thinking about food and eating in non-eating-disordered ways. Eventually, you'll change how you respond to and communicate with people so the eating disorder won't have to do that for you. In addition, your world view that thinness determines your personal worth will shift, and you'll rebuild self-esteem on a more secure foundation.

How well do you know yourself People with eating disorders are often unnecessarily and inaccurately self-critical. That tendency needs to change if recovery is to occur, and that means becoming self-aware. Start the process by taking dictation from yourself and answering the following questions in a journal or notebook. No one will see what you have written without your permission, so be honest Now, let's delve a little deeper to uncover more specific issues, beliefs, or situations that may underlie your eating disorder. Think of yourself as an archaeologist at a dig where you are both the investigator and one being investigated

Your personal inventory should yield a clear picture of many factors that have created the necessary and sufficient conditions for an eating disorder to become part of your life in other words, your negative triggers. Most likely, these are the items you marked with the minus signs. They are called triggers because they operate like the trigger on a pistol, which has to be activated before the bullet can be shot and damage done. So it is with eating disorder triggers once they're activated, anorexic or bulimic behaviors get released and do damage to you. Negative triggers can take many forms, and often more than one is at work. Words that are said to you, looks people give you, being in uncomfortable situations with certain individuals, can all be triggers. They make you react intensely (though you don't usually admit it), and probably feel as though you're constantly ducking defensive, down, anxious, uncomfortable, unhappy, vulnerable, depressed, and in need of some kind of...

After you've identified your negative triggers, the next step is to defuse your eating environment, one step at a time. Again, this has to be an individualized, personal exercise because no two people are alike, and also because what you'll need to do if you're anorexic is likely to be different from what you'll need to do if you're bulimic. One question that anyone in recovery from an eating disorder should answer is, What can I or can't I tolerate We all have limits. If you know what or how much you can eat, with whom you eat, and where you eat before you reach a point at which the anorexic or bulimic patterns get triggered, you can establish a baseline a safely

You might ask your family if you could move in with a grandparent for a short period of time. Make certain your options are acceptable to your family. Gain confidence. The goal is to relearn the skill and pleasure of being able to eat anywhere with anyone and not need the eating disorder to help you do so.

What do you do with this information Use the hierarchy to help you gradually relearn to eat appropriate amounts of foods that you've listed in the forbidden categories. Every time you succeed in moving a food up through the ranks of the hierarchy until it's among your safe foods, you are that much closer to loosening the bonds of your eating disorder.

An important objective of those first steps is to pinpoint why your eating disorder occurs, persists, and becomes powerful 4. When you make an inventory of the people, things, and situations that you believe contribute to your eating disorder, you will have a lot of important information to share with your treatment team. 5. Isolating your negative triggers will help you understand the logic of your eating disorder and change its patterns. 6. Relearning to eat and think about food in a non-eating-disordered way takes time, patience, and a strategy that both makes sense and that you're willing to use. 10. A blueprint for the life you imagine living without the eating disorder (or with it in check) will connect you to a positive goal. Revise it every few weeks as you gain confidence in the process of change.

If you have an eating disorder, it's better (though harder) to decide to come out of your own free will rather than be found out or confronted, as in the previous scenarios. This is because when you come out, you're taking charge. You're also giving permission for other people to help you deal with your eating disorder. When you come out, you may not be able to predict the upshot of your decision, but at least you, and the people with whom you have chosen to share your secret, can refocus your collective energies on recovery.

You'll have to consider the impact of the new way you'll be communicating. The nature of communication with someone who has been entrenched in an eating disorder is often one-sided or absent. So in a way, coming out is a signal that you're ready to reinstate two-way communication even though you may be out of practice. Try to imagine how you'll express your needs and expectations to others. Think about what it will feel like to have others bounce their ideas off yours and to actually consider their positions. Do you really want help in overcoming the eating disorder or do you just want to get people off your case because you're sick of being the object of so much scrutiny Do you want to take an active role in your recovery and do most of the work yourself with the least possible input from outside sources Or are you able and willing to get a variety of people constructively involved in your life and work with them toward a common goal Are you looking for sympathy Do you want to...

Secrecy encourages the maintenance of eating-disordered thoughts and behaviors being open and honest helps you overcome them. Unanticipated Situation 1 Your parent doesn't seem to care that you have an eating disorder. Sometimes parents don't say anything about a child's eating disorder because of fear fear of offending you, fear of finding out the truth, fear of losing your love, fear of making things worse for you. Sometimes parents don't say anything because they literally don't know what to say. They may not understand what's happening and don't have the words to talk with you in the way you need and want. Sometimes parents don't speak out because of their own frustration and anger at not being able to stop their child's eating disorder, and they figure that keeping quiet is preferable to saying (or doing) something ugly or destructive. When you do decide to tell your family and friends about your eating disorder, you must clarify what you need and expect from them. It may take...

Even though you might want to, its not possible (or wise) to keep your eating disorder a secret indefinitefy. 2. Other people who notice your eating disorder symptoms will probably try to get you to change what you're doing and thinking long before you decide to come out 3. If you decide to come out on your own, you may be able to avoid feeling that a power struggle exists between you and the people who challenge your eating-disordered lifestyle. 7. Coming out is a signal that you're ready to reinstate two-way communication and not let your eating disorder keep you isolated from other people.

Having an eating disorder is like entering a maze without map or compass, uncertain where the exits are or how you'll find them. What's more, an extended struggle with an eating disorder can make you so emotionally and physically exhausted that you don't have enough energy to even look for a way out. Perhaps you've tried to overcome your eating disorder on your own, but nothing has worked. You may have relapsed so often that you now assume it will always be the dominant force in your life. This exhausted, depressed resignation is sometimes called hitting a wall or bottoming out. It is a low point that feels so awful that you are willing to see the value of getting some support beyond your immediate friendships and family. You realize that you don't have to be isolated and alone with your illness or in your recovery and that you can ask for and get professional help.

Some hospitals set aside a certain number of beds and call the special section an eating disorder unit, which is usually staffed by doctors, nurses, and other therapists who are specially trained to help you understand and confront your particular challenges. Since patients in these units have similar problems, intense bonds of shared experiences develop and therapy often progresses relatively quickly. Sometimes a person is so ill and in so much denial about the seriousness of the situation, that parents or legal guardians may decide to involuntarily '' admit their loved one to the hospital. This is a controversial step both legally and ethically. However, a study conducted by researchers at the University of Iowa School of Medicine found that even the patients who expressed negative attitudes toward certain parts of the hospitalization appreciated the help they received and did improve clinically over the short-term. (Watson, et al., Involuntary Treatment of Patients with Eating...

It's okay to be anxious about taking medicine, but it's not okay to turn the issue into a power struggle between you and the people who want you to recover from your eating disorder. Taking meds should not become a matter of what they want me to do versus what I want to do.

Therapy offers a structured setting in which you can safely and comfortably let yourself grow and change in productive, non-eating-disordered ways. 7. The first session is usually an intake interview, when you'ZZ be asked to provide information about yourself, your family, and the history of your eating disorder

H Find a qualified therapist who has special training in working with anorexics and bulimics. The Academy for Eating Disorders (AED) (703 556-9222 www.aed-websOrg) and the International Association for Eating Disorder Professionals (IAEDP) (877 540-5691 www.iaedp.com) maintain memberships lists of qualified therapists. Both of these organizations have stringent requirements for professional training before they will allow health care professionals to become members. (This doesn't mean the therapists who aren't members of either group are untrained or unprofessional. It may just mean that they have not applied for membership or haven't yet fulfilled all the continuing education and training requirements for membership.) The AED also publishes an annual directory of health care professionals with information about each member's practice (the geographic location of the office, if they work with children and adolescents or adults, if they do individual, family, or group therapy, how to...

It's especially crucial that you tell them about any and all physical problems along with the emotional issues that are bothering you. For example, if your parotid glands are swollen because you've been vomiting, admit it and don't pretend you've just had a bout of the flu. If your menstrual periods have stopped, don't say that they're irregular. If your gums and teeth are affected by bulimic vomiting, don't blame the problems on too much candy as a child, or poor heredity. she might not ask you about the issues or situations that you feel are problematic and important to discuss. Worse, the therapist may diagnose and want to treat you first for something other than an eating disorder because you've been dishonest about your signs, symptoms, concerns, etc.

By doing all this thinking and preplanning, you've effectively changed the focus of your life from problems to solutions, from negatives to positives. You've made a commitment to therapy and taken the first steps. You're now at a potential transition point in your relationship with family and friends you've confronted yourself and your eating disorder you've admitted the need for help and taken the steps to find it you've shown your strength and guts, and your willingness to grow. You've proven that you can be assertive and self-aware your words and actions show that you can be capable, rational, and assume appropriate control of some aspects of your life. You are building a foundation of competence success breeds success, and confidence comes with competence. Competence is a powerful word that implies readiness, skill, ability, fitness, and proficiency. From this stage of recovery on, others will continue to believe in and respect your competence as long as you remain well-informed...

When you work with a dietitian or nutritionist to overcome your eating disorder, you can expect to learn a great deal about the impact of both adequate and inadequate nutrition on your body. You'll also learn to replace your inaccurate beliefs with the correct facts and strategies to help you recover. The first few sessions will probably address the following questions

Speak up and clarify your position when you want to say something, whether it is positive, negative or neutral. When you get into the habit of being upfront about your thoughts and feelings, you won't need to use an eating disorder as a way to avoid communication or as a substitute for it.

As a former client said, Confidence doesn't come from feeding insecurities. It comes from feeding yourself so you can feel those feelings and then challenge and change thern if you need to. Eating disorders can be used as a way to divert your attention from deeply held feelings, to numb yourself, or put yourself in physical pain so you ignore the underlying emotion and concentrate on the more obvious physical feelings that result from starvation or bingeing and purging. But once you know how to shift the focus and really allow yourself to feel the feelings, the eating-disordered activities are no longer needed and can be eliminated, gradually.

Although much of your recovery has probably been supported by therapists, doctors, and other in-person individuals, sometimes you might want to gather information on your own or talk to someone anonymously. That's when a computer with Internet access can be an ally. There are a variety of online websites that function like virtual reference librarians. Some are maintained by organizations dedicated to education about and prevention of eating disorders. Here is a partial list AED (Academy for Eating Disorders) wwwsuedweb.org ANAD (National Association of Anorexia Nervosa &amp Associated Disorders) wwwANAD.org Giirze Eating Disorders Resource Catalogue www.bulimia.com IAEDP (International Association of Eating Disorders Professionals) www.iaedp.com NED A (National Eating Disorders Association) mYw.nationaleatingdisorders.org Pale Reflections Eating Disorders Community www.pale-reflections.com Something Fishy Website on Eating Disorders www. something-fishy.org These sites are among the...

That said, chat rooms do provide a sense of community. Online groups are sometimes the only way for people who are already in therapy to meet others like them because they live in areas of the country in which eating disorder support groups are unavailable. Strong emotional bonds can be formed and much encouragement and wisdom can be shared online. A chat room discussion gives you the chance to be a mentor If you are long recovered, dropping into a chat room from time to time can help you keep your resolve to remain free of your eating disorder. You will undoubtedly be a source of inspiration and wisdom for someone in that room. On the other side of the coin, because of the anonymity factor, it's relatively easy to ask for advice from others in the online A chat room can be like a continuing education course open to anyone. People who aren't eating disordered may drop in and ask questions or simply listen to the conversational drift. Because a chat room is interactive, it provides a...

Many individuals with eating disorders are athletes who have spent much of their time focused on the connections between (and importance of) peak physical shape and optimal performance. Often, physical activity is severely restricted in the early stages of treatment for anorexia or bulimia. A sure sign of recovery is when you're told you can resume whatever sport or physical, athletic activity that used to be part of your daily life. While that can be exhilarating on the one hand, it also poses a series of challenges. These very qualities can trip you up and make sustained recovery difficult unless you take some steps to avoid being sucked back into the patterns and beliefs of your prior athletic history that supported your eating disorder. 2. Be aware of the female athlete triad which refers to three linked conditions eating disorders, amenorrhea (absence of menstruation), and osteoporosis (bone loss), associated with athletic training (especially gymnastics, figure skating, ballet,...

When you stop, think, and regroup before reacting, you can prevent recurrences of the old, eating-disordered ways. 6. You don't need to numb your feelings or let the eating disorder do your talking for you any more. 8. Once you're allowed to resume athletic activity, you'll have the skills to challenge myths and inaccurate beliefs about sports performance that previously triggered your eating-disordered behaviors.

The principal reason why your good intentions may be misread is that individuals with eating disorders develop abnormal habits and beliefs that interfere with interpersonal relationships. Caring may be misinterpreted as coercion. Compliments may be felt as performance pressure. Attempts at discussion may be misconstrued as accusations. Your honesty may be heard as distortion of facts. What you say or do might be attributed to jealousy of the eating-disordered person or your need to control the situation. Your attempts to see humor in the situation (and there is humor) might be perceived as trivializing the person's struggle and the significance of the eating disorder. Not only can reactions such as these be frustrating, they can cut off communication at the outset if you are not aware that they are more typical than atypical.

It may mean one thing to you and something entirely different to the object of your attention. Your role will vary depending on your relationship with the person, the severity of the eating disorder, the level and intensity of ongoing therapy, and how much energy you choose to expend. It's impor Don't get involved if you believe you will gain control over the other person and teach her (him) a lesson for the pain the eating disorder has caused everybody. Helping is not about one-upsman-ship or righting wrongs. Are you doing this primarily to alleviate your own fright, discomfort, anxiety, and or anger about the eating disorder's impact on everyone's lives If so and your reactions are that intense, first clarify them.

You may hear people say, Sex is the most natural thing in the world ' and it may be, but physical and sexual expression can be excruciatingly difficult for people with eating disorders. Since body-image issues are exaggerated and distortions are commonplace, physical intimacy can be very difficult to achieve and maintain. In fact, it can be frightening. Many young women who have eating disorders will say they feel fat and ugly even when they're not. The tendency is to perceive the self as body parts, scrutinizing their breasts, stomach, hips, thighs, and buttocks instead of being able to look in a mirror and see the whole person. When a particular woman literally cannot see what her lover sees, humor evaporates, joking is impossible, and trust is replaced with doubt. A silly joke or offhand remark can be absorbed as insulting and scornful. The special bonds between people who've been romantically linked are often changed when an eating disorder comes into play. So if you're trying to...

Don't automatically assume these reactions are due to something that you've done wrong. They are more likely to be an indication that the eating disorder has too strong a hold on the person and professional intervention is needed. Or, they may mark a transitional phase when the eating disorder is becoming more severe and occupying more of the person's head space. They may be a response to feeling intense pressure to get well from outside sources (i.e., you), but the person hasn't reached the point of recovery readiness. Also, as mentioned before, an eating disorder often functions as a barrier that excludes not only people who have previously been significant (and you may fall into that category), but things such as interests and hobbies.

People who have eating disorders usually have a lot of self-doubt. Many come from backgrounds in which appropriate, productive communication is lacking or absent. As a result, they often don't feel comfortable speaking up for themselves or might not think they have the right to do so. They might not even know how to clearly state their needs and expectations. Even worse, some might have been punished when they tried, and then stopped altogether. But needs and expectations don't just go away because they're ignored or repressed. After a long period of time, those unexpressed thoughts and emotions build up until the pressure becomes so uncomfortable it has to be released. An eating disorder is often the outlet. If the person you're trying to help has a similar kind of history, you should modulate your helping approach accordingly. Try to avoid being brutally honest or confrontational so you don't accidentally and unintentionally threaten the person's already unsteady sense of self. This...

What about relationships that have been damaged by an eating disorder Can they be rebuilt or repaired The answer is a qualified, Yes. Often, when people with eating disorders get far enough along in recovery, they feel compelled to try to restore relationships that were once important to them. This could happen after they repeatedly

If you care about someone who has an eating disorder and want My college roommate had her third bout with anorexia during our freshman year It was rugged. Because my mom is a therapist, I knew a lot about eating disorders long before I went to college, but I also knew about them because a close girlfriend in high school was bulimic. So you could say that I was a natural for helping. I tried again and again to be supportive of my roommate. I gave her books to read, we wrote gratitude journals together, I'd sit up with her nights listening to her crying because of frustration and self-doubt, I talked to her boyfriend when she was afraid to, and I tried to eat meals with her, though that made me want to scream.

Your helping role will vary depending on the severity of the eating disorder, the time frame of recovery, the level and intensity of therapy, and the nature of your relationship to the person. 8. Romantic partners as helpers face special challenges because of the ways in which eating disorders impact intimaqr issues.

Even if the initial intake experience seems overwhelming, alarming, or intrusive, give it your best. If you don't, and you're not honest and direct, the interviewer might make an incorrect initial diagnosis. He or she might even think your problem isn't really an eating disorder and suggest that you should focus your therapy efforts on something else. If you misrepresent yourself on intake, or worse, are hostile, the interviewer therapist could think you're not really ready for therapy, and recommend that you wait until you are ready or that you go elsewhere for treatment (though this doesn't usually happen). The questions pertaining to the eating disorder will vary, and may seem to you the most unsettling of all. Here are some more possible topics

People who have eating disorders don't often know the meaning of being appropriately selfish and tend to put their own needs and wants far down their lists of priorities and to-dos. If you're going to let go of an eating disorder, you must put something else in its place. That is where your hobbies and interests can be effective. Figure out what you like to do (not what you think you should like, or what you think someone else wants you to like) and try to find a balance between work and play. Perfectionism can't be allowed to enter the picture eliminate the word perfect from your vocabulary. The simplest relaxation techniques such as taking a bath, going out for a walk, listening to soothing music, stroking your pet, lighting incense and candles in your room and reading quietly can help, as can more skill-based techniques such as yoga.

I noticed scars on my girlfriend's knuckles soon after we started dating and I knew she'd been going to the dentist a lot lately, so I made the assumption that she was a bulimic. That's when I found out a little knowledge could be a dangerous thing. Instead of asking her point-blank, I kept sneaking in references to bingeing and purging and how bad it was for you. I even looked through her bathroom cabinets for laxatives. I thought I could help her since she liked me so much and we got on so great. But she caught me snooping. She let me have it Her scars were from an old riding accident and she was going to the dentist to have a crown on her molar repaired. We'll never go out again she was that mad at me. You can avoid mistakes like Randolph's by being direct. If you suspect that someone you know has an eating disorder, talk to her or him before you do anything. You may not get a straight answer, but at least you'll be playing with your cards face-up on the table. That way, you're...

Another helpful step in early recovery is to develop a vision for the life you imagine living without the eating disorder, or at least with it in check. Once you decide to be the architect of your own recovery and create your own blueprint for change, you're in a position to recognize that eating-disordered choices and behaviors are not ordinary and natural. They're dangerous and self-destructive. This means that your blueprint should start out simple. Small steps are fine. Pick out one or two tasks to defuse the negative triggers you really want to work on and think you can conquer. For instance, eat one non-eating-disordered meal per weekend with the family or limit what you buy in preparation for a binge. Perhaps when something is making you uncomfortable and is triggering you, clearly state what's wrong in the moment to the person whose behavior is problematic. Keep at it until the individual tasks you've selected no longer trigger an eating-disordered response. You will gain...

If you have anorexia, you hate fat (maybe even fear it) and deny yourself the right to eat the way most people do. You may ban red meats and processed meats (such as bologna and hot dogs) from your diet altogether and restrict yourself to eating small amounts of white meat, poultry, and non-fatty fish. You cut out foods such as mayonnaise, peanut butter, hard cheeses, butter and margarine, and avoid sweets and desserts, processed breads and sugary cereals. If confronted, you justify your food choices by saying you know a lot about nutrition and you're just eating healthy by cutting down on fats and cholesterol in your diet. You probably allow yourself certain safe foods such as low-calorie vegetables, crunchy fruits such as apples, salads with vinegar (balsamic is a favorite) or no-oil salad dressings, plain popcorn, unsalted rice cakes, low-fat cottage cheese, and nonfat yogurt, but only in limited amounts. Many of you say that you are vegetarian so many, in fact, that a study...

You might develop private rituals to divert your attention from the physical discomfort of hunger and block out the eating disordered thoughts bombarding your brain. Without the rituals you might have trouble doing even the most ordinary things. For example, you may need to touch a certain piece of furniture before walking out the door, make yourself do one hundred sit-ups for each bite of food you allow yourself to eat, or break off half of every pretzel or cracker and throw it on the floor before you let yourself eat the other half. You may only swallow food after you've chewed each mouthful a set number of times, not allow an eating utensil to touch your lips, ait your food into tiny pieces, not wash the dishes you've used until the end of the day so you can count them, and so on. Rituals are as unique as the person who creates and performs them. You tend to get very strict about these rituals and don't like anyone to interfere when you're performing them. You also lose your sense...

It can be tough to get motivated to do all this soul searching and make life changes, especially if you think your eating disorder isn't that serious. You may not yet perceive (much less believe) that your physical and emotional well-being are impaired or at risk. What's worse, since anorexia and bulimia can start out as behaviors that seem normal and acceptable in our culture, you might be rationalizing your early symptoms by saying things like,

Once you've finished with these self-awareness questions, it's helpful to organize what you've learned about yourself in chart form, such as the personal inventory in the following example. In your case, you're taking inventory of and making decisions about people, things, and situations that affect your feelings and attitudes about food and eating as well as about your self-image and self-esteem. It will help you clarify the ABCs of your anorexia and or bulimia Antecedents, or what came before Behaviors, or what is happening now and Consequences, or results. Mark anyone or anything that was or has been positive with a + and conversely, the negative influences with a

Some therapists are comfortable with self-disclosure and are willing to talk a bit about themselves during a session, if doing so is appropriate to the ongoing therapy. In fact, many people who work in the field of eating disorders have recovered from the disorders themselves and will share their experiences during therapy. Others

Cognitive therapy (CT) focuses on your thoughts and how your beliefs and perceptions shape your emotional responses. This type of therapy teaches you to recognize the unproductive and disapproving ways in which you think and talk about yourself, sometimes called scripts, themes in your thinking, or negative self-talk. Once you're aware of these negative patterns, you can understand how they contributed to the development and maintenance of your eating disorder and you can challenge and change them.

Family therapy is a crucial component of the healing process because eating disorders are often a response to problems within the family, such as difficulties with open expression of feelings, conflict, and lack of support between family members. An eating disorder can also be a response to familial trauma such as addictions, mental illness, sexual, physical or emotional abuse, suicide attempts or suicides, incarceration, or any other major stressor. As hard as it is to admit you're anorexic or bulimic, it can be even harder to own up to the probability that something in the way your family operates has played a part in your eating issues. You might feel protective or even responsible for maintaining family harmony and happiness. But that responsibility is never solely yours, and family therapy can be a safe place to talk about this kind of delicate issue. Together, you can try to identify, discuss, and repair many of the delicate, sensitive issues that maintain your eating disorder.

When you meet with a psychiatrist during your initial therapy sessions, its possible that you'll be offered medication as part of your treatment. Drug therapy for eating disorders began many years ago when doctors discovered that some medicines originally used to treat other diseases helped alleviate some of the more obvious symptoms of anorexia and bulimia. These drugs also had a beneficial effect on the anxiety, panic, compulsions, and obsessions that are characteristic of eating-disordered thinking and behaving. Several drugs are used today, and new ones are added when the FDA deems them safe. Consequently, doctors are continuously updating their knowledge about how these medications can maximize symptom relief with a minimum of uncomfortable side effects.

If you have anorexia and or bulimia and decide to go into therapy, you may be exposed to all these therapy formats at one time or another. Many people may be involved in your care at the same time, but that just makes the process interesting and helps you learn to express yourself effectively and accurately. The process may sound more complicated than it really is. Therapy unfolds it won't bowl you over. You won't be faced with everything at once. Therapy isn't designed to frighten or overwhelm you, though at times it may seem overwhelming and scary. It's an opportunity to be challenged, learn to set goals, establish priorities, test strategies, succeed, goof up, succeed again, and eventually find your way out of the eating disorder maze.

Changing something that's familiar to you, even if that something is harmful, can be difficult to do. When that something is an eating disorder, the motivation to change can be further complicated by your history, especially if you've previously tried and failed to overcome your problem or have spent a lot of time denying that the problem even existed. You may have little hope that you'll succeed this time and assume that you'll always be stuck in your current patterns. You might be skeptical about therapy and therapists. It's only logical, then, that you'd hesitate to ask for, much less accept, assistance. Instead, if you've been through this before, try to reframe your present situation in positive, proactive terms. Whether you're having a temporary lapse in recovery or a more severe, prolonged relapse, think of the flare-up as a wake-up call that you need additional help to renew your commitment to life without an eating disorder. In either case, it takes a lot of courage to decide...

Another great way to strengthen your recovery process outside the treatment setting is to attend self-help (support) groups. These can be found on college campuses, as adjuncts to in-patient or out-patient therapy programs, as informal groups of people in varying stages of recovery, or as components of existing Overeaters Anonymous programs, and so on. Self-help groups meet in a variety of settings, including rented space at local churches, hospitals, or members' homes. Typically, participants include people who are in recovery from some form of eating disorder (and perhaps additional psychological or addictive challenges) and their families or friends. It might surprise you that many people with anorexia and bulimia attend meetings of Overeaters Anonymous (OA), an organization founded in 1960 for compulsive overeaters and patterned after the twelve-step program of Alcoholics Anonymous (AA). Some bulimics find OA's strict requirements comforting and helpful you limit yourself to three...

Learn as much as you can about eating disorders before you offer help of any kind. Reading this book and others, searching the web for information, and talking to other people (professional or otherwise) who have experience with eating disorders are all ways to build an accurate knowledge base and become aware of the complexities inherent in recovering from anorexia and bulimia. It's also important to be on-target when you evaluate the seriousness of the problem and anticipate arguments the other person might use to prove you wrong.

Sometimes laughing at the very things that get you down is therapeutic, and in this situation, humor can be a useful tool for you and the person you're trying to help. You can start out by poking gentle fun at yourself for being clumsy in your approach to things. You can mimic how therapists talk. It's plausible that if the two of you become comfortable laughing together you'll eventually be able to talk about more difficult issues (the key concept here is comfortable because that implies neither of you will be in a defensive posture). If you decide to take the lighthearted approach, be aware of your delivery. What is humorous to you might not be humorous to the other person. Make it clear that you're trying to defuse some tension and you are not trying to minimize the seriousness of the eating disorder and the suffering it causes. You can laugh together about almost anything that pertains to an eating disorder, as long as you both agree that it is okay. You might find it funny that...

Straight Facts About Anorexia In many ways anorexia is stronger than grief, more abiding than love. Anorexia nervosa is a dangerous eating disorder that harms you both physically and mentally as you starve yourself in a quest for thinness. Anorexia means loss of appetite ' but that's misleading when you are anorexic, you're almost always hungry. Through sheer willpower, stubbornness, and tenacity, you deny your hunger, learn to suppress it, and sometimes revel in its discomfort as proof of your strength and self-control. We can say with certainty that anorexia nervosa affects many more females than males, regardless of their ages. The American Academy of Pediatrics Committee on Adolescence estimates that .5 of teenage girls and young women are anorexic. (Pediatrics, 2003 111 204-211) Other estimates, cited in various resources ranging from professional journals to online educational websites about eating disorders, suggest the number may be higher, between 1 and 4 . Approximately 0.2...

Often directed by a child psychiatrist. Although good collaboration exists among pediatric colleagues, the same is not always true with the separately organized departments of medical health psychology and behavioral medicine. Some UMCs have pediatric medical-psychiatric units or specialized treatment programs for eating disorders, somato-form disorders, and elimination disorders.

There are many ways of dealing with psychosomatic patients. First, identify the disorder Do not miss the possible diagnosis of an affective or anxiety disorder. Treatment of somatization is directed toward teaching the patient to cope with the psychological problems. Be aware that somatization operates unconsciously the patient really is suffering. Above all, the patient should never be told that his or her problem is ''in your head.'' Anxiety, fear, and depression are the main psychological problems associated with psychosomatic illness. The list of associated common symptoms and illnesses is long and includes chest pain, headaches, peptic ulcer disease, ulcerative colitis, irritable bowel syndrome, nausea, vomiting, anorexia nervosa, urticaria, tachycardia, hypertension, asthma, migraine, muscle tension syndromes, obesity, rashes, and dizziness. Answers to an open-ended question such as ''What's been happening in your life '' often provide insight into the problems.

A small number of standardized assessment tools and semistructured interviews are used in the specialty of adult psychosomatic medicine and can serve as a template for use in selected pediatric populations. These include the Primary Care Evaluation of Mental Disorders (PRIME-MD), a 26-item, self-administered questionnaire that screens for five of the most common groups of disorders in primary care depression, anxiety, alcohol use, somatoform disorders, and eating disorders (Spitzer et al. 1994). The PRIME-MD has been adapted as a self-report measure called the PRIME-MD Patient Health Questionnaire (Spitzer et al. 1999). In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Primary Care Version (DSM-IV-PC American Psychiatric Association 1995), contains diagnostic algorithms to evaluate eight common categories of psychiatric disorders, including depression, anxiety, cognitive abnormalities, substance use, unexplained physical symptoms, sleep and sexual...

It might sound funny, but it's no laughing matter to be completely preoccupied with fat. Certainly, a low-fat diet is an essential part of being healthy however, taking this concept to radical extremes can place serious restraints on social eating, let alone set you up for a serious eating disorder. If your reason is weight control, think again. Some fat is fine, and I promise you can maintain your ideal body weight (within reason, of course) and still allow yourself to enjoy foods with fat every once in a while.